The overall goal of the project is to develop indicators of technical quality of care related to clinical management systems based an reports by ambulatory care patients. A collaboration is proposed with two health plans (Harvard Community Health Plan and Henry Ford Health Care Corporation in Detroit) to develop methods to measure performance of 12 clinical management systems. Questionnaires will be developed and mailed to populations of patients who (1) have been enrolled a year, (2) had a recent visit, (3) had a recent abnormal laboratory test, (4) had a recent referral for consultation, and/or (5) had a recent chronic disease visit, asking then to report on their experiences with the performance of the selected clinical management systems. For patients who agree to participate, plan data sources concerning the same events reported in the questionnaires will be examined. Data from each patient questionnaire will be matched to the related data from plan sources to determine if these two sources agree an whether (1) one of the twelve systems was involved, (2) an error occurred. Rates of system errors will be constructed, and their patterns of occurrence explored. Using the plan data as the gold standard for both numerators and denominators of these rates, sensitivity, specificity and predictive value of patient reports will be determined. The relationship of these properties to selected characteristics of the patients and of their health care, including measures of patient satisfaction and functional health status, will be investigated. Rates will be combined into a short set of indicators to provide feedback reports to plans. Costs of production of these reports will be assessed.